I am a plastic surgeon in Little Rock, AR. I used to "suture for a living", I continue "to live to sew". These days most of my sewing is piecing quilts. I love the patterns and interplay of the fabric color. I would like to explore writing about medical/surgical topics as well as sewing/quilting topics. I will do my best to make sure both are represented accurately as I share with both colleagues and the general public.

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Monday, April 28, 2008

Updated 3/2017-- photos and all links removed as many are no longer active and it was easier than checking each one.

I am seeing more advertisements and a few articles in journals regarding barbed sutures. I find the concept interesting. The supposed benefits include:

less time to close the incision as there is no tying

multiple layers (subcutaneous and dermis) can be closed together with one continuous suture

less suture "spitting" as no knots to be dissolved

less or no strangulation of tissue as there are no knots tied

no need for an assistant to "follow" the suture

The Barbed sutures are sutures with small projections that radiate outward from the center of the suture. For example, the suture may be made by cutting the surface of 2-0 polypropylene to create small projecting barbs, all angled in one direction and helicoidally arrayed around the length of the suture core. The core of the barbed suture is then equivalent to a 4-0 polypropylene suture. Barbed sutures come in both permanent ( polypropylene and nylon) and dissolvable (polydioxanone) forms.

While Barbed sutures offer the promise of minimally invasive facial suspension (ie Threadlift, Featherlift , etc), I am more interested in how they might be used in vertical scar mastopexy or abdominoplasty or other body contouring procedures. Also, the use in tendon repair (no strangulation of the tendon) is worth watching.

Here are some basic instructions found on the Quill SRS Website:

QuillTM SRS contains bidirectionally oriented barbs to anchor tissues and does not require knots to approximate opposing edges of a wound. Tying of knots with QuillTM SRS will damage the barbs and potentially reduce their effectiveness. For the bidirectional forces to be created and for the device to function properly, both sides of the QuillTM SRS must be engaged in the tissue. Additionally, when completing placement, an additional J-stitch or bite of tissue lateral to the end of the incision is required to lock the device in place.

Avoid contacting the QuillTM SRS with other materials (e.g. surgical gauze, drapes, etc.) in the surgical field to prevent ensnaring on the barbs. If the barbs catch, carefully pull the material in the opposite direction of the needle to disengage it from the barbs.

When using QuillTM SRS subcutaneously, the device should be placed as deeply as possible in order to minimize erythema and induration normally associated with absorption.

Care should be taken to avoid damage when handling. Avoid crushing or crimping the suture material with surgical instruments, such as needle holders and forceps. Do not pull the QuillTM SRS out of the package by the needles as this can cause the barbs to catch on one another. Do not attempt to remove memory in the polymer by running fingers down the suture material as this can damage the barbs.

I would think that some down sides to using barbed sutures might be:

need to "never" redo a stitch placement as you can't "back" the suture out

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